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Imagine a scenario in which hospital leadership insisted on switching to a new electronic medical record (EMR) without first consulting the staff who use it?

Four radiologists were asked how they would handle a hypothetical EMR transition if it resulted in a loss of referrals, scheduling mix-ups and additional radiologists needed to complete basic tasks. Their answers were published in a recent Journal of the American College of Radiology article.

Not surprisingly, all four pointed to a disconnect between radiologists and hospital administrators as the source of the problem, but all focused on how they would arrive at a solution.

Carolyn C. Meltzer, MD, with Emory University in Atlanta, said radiology leaders should have been part of the transition process, starting with its selection, but argued an interdisciplinary working group would be necessary to reverse the damage.

“The hospital cannot function properly unless radiologists and radiology informatics specialists are integrated with the health system’s IT team,” she wrote. “Broad communication to all stakeholders and transparency of process and timing for milestones is also critical.”

For David M. Yousem, MD, with Johns Hopkins School of Medicine, the proof is in the data, writing he would begin a project to document the failing EMR’s cost in physician hours, lost referrals, patient dissatisfaction, administrative overtime and more figures.

He would also provide an improvement plan focused on correcting specific problems with the EMR or vendor proposals if necessary. These suggestions would mean little without departmental leadership endorsement, he argued, and a petition from stakeholders.

“In unity there is strength,” he wrote. “In the end, if the executive leadership of the hospital insists on remaining with the ‘flawed’ EMR, I would work within the system to improve it and make lemonade from lemons.”

In a similar vein, Cindy Sherry, MD, with the department of Radiology at Texas Health Presbyterian Dallas expressed that radiologists should have been involved in the EMR selection process, noting the situation could have been avoided if the administration had an imager in their ranks.

Like Yousem, she suggested stakeholder feedback and research options would provide the best evidence of the EMR’s failures. A financial statement outlining the cost of a fix—paired with an estimate of potential dollars lost as a result of future dissatisfaction and legal issues—may be a step in the right direction.

Some radiologists, like Thomas M. Grist, MD, with the University of Wisconsin, were more adamant about their positions than others, suggesting he would work to get new hospital administrators.

“I would never accept being forced to adopt something as impactful to our clinical care as a disastrous EMR platform,” he said.

All four had strong opinions on the scenario. They agreed that after coming to terms with the situation, strong financial evidence and support from stakeholders and leadership would ultimately help right the sinking EMR ship.

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